Project Abstract Hypertension (HTN) is a leading cause of morbidity and mortality worldwide. It affects almost 850 million people worldwide and is a primary risk factor for strokes and other cardiovascular diseases. The burden of hypertension is greatest in low-and middle-income countries, and is disproportionately increased in the Caribbean region. Food insecurity (FI), an economic or social condition of limited or uncertain access to adequate food, has recently emerged as a contributing factor in the development and poor management of chronic diseases in US and Latin American populations. Studies demonstrate a relationship between FI and poor dietary quality, obesity, diabetes and stress. However, few studies have included food insecurity in investigations of hypertension, and among those that have, results are mixed. FI is a major public health problem in the Caribbean region and may be particularly relevant to investigations of hypertension. People with FI consume cheap, calorie dense foods that are ultra-processed and high in sodium. Persons with FI and diet sensitive conditions have poorer control, more emergency visits, and complications. The proposed study leverages data from the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS), a first of its kind community-dwelling cohort across four Caribbean islands, to determine whether food insecurity influences the development and management of hypertension in the Caribbean.